Jefferies London Healthcare Conference November 2019 · • Myasthenia Gravis • Rheumatoid...
Transcript of Jefferies London Healthcare Conference November 2019 · • Myasthenia Gravis • Rheumatoid...
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TarGeting B-Cell Diseases
Jefferies London Healthcare Conference
November 2019
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This presentation contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements are often, but not always, made through the use of words or phrases such as “anticipates”, “expects”, “plans”, “believes”, “intends”, and similar words or phrases. Such statements involve risks and uncertainties that could cause TG Therapeutics’ actual results to differ materially from the anticipated results and expectations expressed in these forward-looking statements. These statements are only predictions based on current information and expectations and involve a number of risks and uncertainties. Actual events or results may differ materially from those projected in any of such statements due to various factors, including the risks and uncertainties inherent in clinical trials, drug development, and commercialization. You are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. All forward-looking statements are qualified in their entirety by this cautionary statement and TG Therapeutics undertakes no obligation to update these statements, except as required by law.
Forward Looking Safe Harbor Statement
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TG is a biotechnology company focused on developing
medicines for patients with B-cell diseases:
• Chronic Lymphocytic Leukemia
• Marginal Zone Lymphoma
• Follicular Lymphoma
• Diffuse Large B-Cell Lymphoma
• Multiple Sclerosis
• Myasthenia Gravis
• Rheumatoid Arthritis
• Lupus
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Unique Approach to Drug Development
IDENTIFY ACQUIRE DEVELOP
Identify validated targets for B-cell
diseases
• Based on preclinical or clinical data known to be important in the treatment of B-cell disease
Search & Acquire “Best-in-Class”
Compounds
• Compounds that have the potential to offer improvements over available therapies
Develop Multi-drug Combinations
• To develop functional cures for cancers requires multiple drugs…solutions development
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B-Cell Focused PlatformClinical Stage Portfolio Overview
Product
Mechanism of
Action
Stage of
Development
Umbralisib (TGR-1202) PI3Kδ/CK1ε Phase 3
Ublituximab(TG-1101) Anti-CD20 Phase 3
TG-1501 Anti-PD-L1 Phase 1b
TG-1701 BTKi Phase 1
TG-1801 Anti-CD47/CD19 Phase 1
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Marginal Zone Lymphoma YE 2019
Umbralisib: Investigational Targeted Therapy with “Best-in-Class” Potential
LATE CLINICAL
DEVELOPMENT
US REGULATORY
SUBMISSION PLAN
CLL (in combo with Ublituximab) 1H2020
Follicular Lymphoma 2020
Small Lymphocytic Lymphoma 2020
Umbralisib
Next Generation PI3K delta inhibitor
Overcomes 1st generation Toxicity
Activity across NHL and CLL
Once daily oral dosing vs. BID or IV
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First Generation PI3K-delta’s are highly active but tolerability has limited market utilization
(1) Zydelig full-prescribing information; (2) Copiktra full-prescribing information; (3) Aliqopa full-prescribing information
• Fatal and/or serious hepatotoxicity occurred in 16% -18% of Zydelig-treated patients
• Fatal and/or serious diarrhea or colitis occurred in 14% - 20% of Zydelig-treated patients
• Fatal and/or serious pneumonitis occurred in 4% of Zydelig-treated patients
• Fatal and/or serious infections occurred in 21% - 48% of patients treated with Zydelig monotherapy
• Fatal and/or serious infections occurred in 31% of Copiktra-treated patients
• Fatal and/or serious diarrhea or colitis occurred in 18% of Copiktra-treated patients
• Fatal and/or serious cutaneous reactions occurred in 5% of Copiktra-treated patients
• Fatal and/or serious pneumonitis occurred in 5% of Copiktra-treated patients
• Infections: Serious, including fatal, infections occurred in 19% of Aliqopa-treated patients
• Hyperglycemia: Grade 3 or 4 hyperglycemia occurred in 41% of Aliqopa-treated patients
• Hypertension: Grade 3 hypertension occurred in 26% of Aliqopa-treated patients
• Non-Infection Pneumonitis:Occurred in 5% of Aliqopa-treated patients
• Severe Cutaneous Reactions:Grade 3 and 4 cutaneous reactions occurred in 2.8% and 0.6% of Aliqopa-treated patients, respectively
Black-Box Warning(1) Black-Box Warning(2) Warnings and Precautions(3)
Market is in need of a well tolerated PI3K-delta
DuvelisibIdelalisib Copanlisib
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Umbralisib: Selectivity
Umbralisib
DiscoverX KINOMEscan
Burris, et al., Lancet Oncology 2018
Umbralisib exhibits greater selectivity to PI3k-delta compared to other PI3K
inhibitors
Red circles indicate which kinase is being inhibited
The larger the red circle, the stronger the relative inhibition of the kinase
Delta
In-vitro kinase profiling – all compounds at 1µM
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Umbralisib: Selectivity
CK1e
DiscoverX KINOMEscan
Burris et al., Lancetr Oncology 2018; Maharaj et al., ASH 2017
PI3K associated immune-
mediated toxicities are thought
to be related to impaired Tregs
(Lampson et al., Blood 2016)
Umbraliib uniquely inhibits
CK1-epsilon, an important
conduit which may play a role
in Treg development and
function
Combination of CK1-epsilon
targeting and lack of inhibition
of PI3K gamma may prevent
impairment of Tregs, explaining
the improved tolerability profile
observed for umbralisib.
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Discontinuations
due to AEs were
rare at under 10%
Davids et al, EHA 2018
Integrated Safety Analysis of Umbralisib (n=347)
Umbralisib: Tolerability
All Grades, All Causality, AEsOccurring in >15% of Patients
Diarrhea 44%
Nausea 39%
Fatigue 35%
Neutropenia 22%
Anemia 20%
Vomiting 19%
Dizziness 18%
Thrombocytopenia 18%
Cough 17%
Decreased appetite 16%
Headache 16%
Neutropenia 16%
Anemia 5%
Thrombocytopenia 5%
Diarrhea 4%
Pneumonia 4%
Dyspnea 3%
Hypokalemia 3%
Grade 3/4, All Causality, AEs Occurring in >2% of Patients
Immune-mediated adverse events were infrequent: transaminitis (9%; Gr.3/4 2%); colitis (<1.5%; Gr.3/4 <1%); pneumonitis (<1.5%; Gr.3/4 <0.5%)
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CLL FL MZL
Umbralisib Single Agent Phase 1 Results (as published in Lancet Oncology)
Umbralisib: Activity
Lancet Oncology, February 2018
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Data Supporting Planned Umbralisib Filing In MZLBreakthrough Therapy Designation Granted
Fowler N, et. al., ASCO 2019
MZL Preliminary Safety & Tolerability
Umbralisib was deemed to be well tolerated
No events of colitis reported
AE’s leading to dose reduction occurred in 6 subjects (9%)
10 subjects (14%) discontinued umbralisib due to an AE considered at least possibly related to treatment
No deaths occurred on study
Grade 3 infections were limited, occurring in 3 patients (bronchitis, pneumonia, and influenza)
MZL Trial met primary endpoint exceeding target 40% ORR
Following Discussions with FDA Plan to Commence Rolling
Submission around YE2019
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MZL patients have few treatment options and no available cures
Approximately 7,500 new cases per year, with ~3,000 relapsed
patients needing treatment each year
Second largest indolent form of NHL
Affects mostly elderly individuals
Need for highly active, well-tolerated treatment option for MZL
Umbralisib: Convenient oral daily dosing appears well tolerated with
~50% ORR in MZL
Chemo-immunotherapy: non-specific, toxic contraindicated
in certain unfit elderly patients
R2: recently approved Revlimid plus Rituxan– can cause
severe neutropenia and rash; secondary malignancy risks
Ibrutinib: accelerated approval – less than half of patients
respond; tolerability issues
PI3K Delta inhibitors: none approved
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UNITY-NHL Umbralisib Monotherapy CohortFollicular Lymphoma (FL)
UNITY-NHL TrialFL Cohort
Fully Enrolled
Umbralisib
(TGR-1202)
Monotherapy
Follicular Cohort Met Primary End Point
Exceeding 40% ORR hurdle
Umbralisib monotherapy appeared to be
well tolerated with a safety profile
consistent with previous reports
TG plans to discuss the results with the
FDA to determine submission opportunities
for accelerated approval in FL
Other PI3K delta’s obtained accelerated
approved (range: 42% - 59% ORR)
Approximately 15,000 new FL cases per year
with ~7,500 relapsed patients needing
treatment per year
Full Enrollment
Complete
Target ORR 40-50%
Enrollment Complete 3Q-18
Target Full Data
Presentation
2020
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Relapsed/Refractory Indolent Commercial Opportunity
Sources: (1) Lymphoma Research Foundation; (2) Putnam Associates, 2018; (3) Thieblemont C., et al. Blood 2016; (4) TG Therapeutics AACR 2019
Market Overview
Two largest group of indolent lymphomas
(FL & MZL)1
~6,000-10,000 Patients inR/R Setting2
Median age at diagnosis is 60 years.1
Vast majority of patients will experience a relapse.3
Safe
ty
Umbralisib(MZL)
Once-daily, oral, non-chemotherapy treatment that is well tolerated and
efficacious4
CR = ~20%
No colitis
ORR = ~50%
Current Landscape
For a patient population that will ultimately experience multiple
lines of therapy, current options represent suboptimal tradeoff
between efficacy and safety
Efficacy
BTK
CD20 Regimens
Umbra &U2
PI3K Delta’s
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Multiple Sclerosis YE 2020
Ublituximab: Investigational Next Generation Anti-CD20 Monoclonal Antibody
LATE CLINICAL
DEVELOPMENT
US REGULATORY
SUBMISSION PLAN
CLL (in combo with umbralisib) 1H 2020
Ublituximab
Glycoengineered for enhanced potency over 1st generation
Activity in Rituxan refractory patients
Shorter infusions than all other anti-CD20s (1-1.5 v 3-4 hours)
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Early Clinical Data for Umbralisib and U2 in CLL Support Successful Phase 3
Study Enrollment ~420
Primary Endpoint PFS
Target PFS Readout 2H-19/1H-20
Patient Population 1L/2L+
Conducted under Special Protocol
Assessment
Progression-Free Survival
(Published in
Lancet Oncology
February 2018)
85% ORRUmbralisib
monotherapy
(at higher doses)
Median PFS for Umbralisib Monotherapy: 24 Months
Mato A, et. al, EHA 2016
Median PFS and DORnot reached for U2
U2 Umbralisib
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CLL is One of the Fastest Growing Global Hematology Markets
~115,000 Americans living with CLL
~20,000 newly-diagnosed patients each year
~20,000 previously treated patients seeking treatment each year
*Evaluate Pharma
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Chemo-immunotherapy: non-
specific, toxic contraindicated in
certain unfit elderly patients
BTK inhibitors: tolerability issues can
be significant
PI3K delta inhibitors: tolerability
prevents widespread utilization;
idelalisib contraindicated in first line
therapy
BCL2 inhibitors: potential for severe
tumor lysis syndrome requires
enhanced monitoring and
hospitalization in many cases
Need for additional highly active, well-tolerated
treatments for CLL
CLL remains incurable despite new treatment options
50,000+ patients treated in the US
135,000 patients treated WW
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U2 Offers a Needed Novel Treatment Option for CLLAlternative to or Complementary with Standard of Care
This slide represents the landscape from the Company’s perspective. Actual results may differ materially from those assumed by the Company and should not be relied upon for any purpose.
~36,000 CLL Patients Initiate a New Line of Therapy Annually in the US
BTK Experienced
BTK Naïve
Community Practices85%
Academic Practices15%
In poor candidates for BTK
+ BTK to enhance efficacy
In patients
rel/ref/intolerant to BTK
In patients rel/ref/intolerant
to BTK
+ Ven with curative intent
*Venetoclax currently has limited utilization in the
community due to monitoring/safety challenges
In poor candidates for
BTK/Ven
+ Ven with curative intent
+ BTK to enhance efficacy
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B-Cell Platform Provides Next Gen Combo’s
Nastoupil et al, Lugano 2017
Mato, et al. ASH 2018
U2+Venetoclax:
• Rel/Ref CLL
• 100% PB MRD-
• Best reported to date
U2+TG-1701:
• Rel/Ref MZL/FL
• 100% ORR at lowest
dose tested of 1701
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Ublituximab in Multiple Sclerosis
~1M Americans living
with MS
Completed Phase 2
ECTRIMS 2019:
Final Phase 2
efficacy data &
long-term safety
data
First look at
ULTIMATE I & II
Phase 3 study
design & patient
demographic data
Fully Enrolled Phase 3 ULTIMATE Trials
under Special Protocol Assessment (SPA)
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MS – Phase 2 ARR Comparison
0.05
0.13
0.64
0.36
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
UblituximabWeek24Phase 2(n=48)
OcrelizumabWeek 24Phase 2(n=55)
PlaceboWeek 24Phase 2(n=54)
Rebif(interferon beta-1a)
Phase 2(n=54)
Annualized Relapse Rate (ARR) Comparator
Final Ublituximab Phase 2 Data at Week 48
48 patients through 48 weeks of treatment
Annualized Relapse Rate of .07
Fox et. al., ECTRIMS October 2018
Kappos L et al. Lancet. 2011; 378:1779-1787
Hauser SL et al. NEJM. 2017; 376:221-234
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Ublituximab Phase 2: MRI-Gd Enhancing Lesions
Fox E et al., ECTRIMS 2018
No T1 Gd-enhancing
lesions were detected in
any subjects at Week 24 or
Week 48
(100% reduction; p=0.003)
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Significant Opportunity for Ublituximab in MS
Global Prevalence = ~2.3Million
Global Market Size >$30Billion by 2025
Source: Datamonitor 2018 MS Report
Prevalence Estimate: Nat’l MS Society
Roche JPM 2018 Corporate Update
0
5
10
15
20
25
30
35
2018 2019 2020 2021 2022 2023 2024 2025
$ B
illio
ns
Estimated Global Sales
US Ex-US (Japan, France, Germany, Italy, Spain & UK)
Current estimated ocrelizumab share: ~12% of total MS market
Ocrelizumab >$2 Billion in 2018 annual sales
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Source: Evaluate Pharma, Wall Street Research
Multiple Treatment Options Coexist & Account for Meaningful Market Share
Class Drug
U.S. Approval
Date Route of Administration Dosing Global 2018 Revenues by Drug/Class ($ in millions) Global Historical Revenues by Class
Betaseron 1993 Subcutaneously 1x / 2 days
Avonex 1996 Intramuscularly 1x / week
Rebif 2002 Subcutaneously 3x / week
Extavia 2009 Subcutaneously 1x / 2 days
Plegridy 2014 Subcutaneously 1x / 2 weeks
Tysabri 2004 Intravenously 1x / 4 weeks
Lemtrada 2014 Intravenously 3x / year
Gilenya 2010 Orally 1x / day
Aubagio 2012 Orally 1x / day
Tecfidera 2013 Orally 2x / day
Ocrevus 2017 Intravenously 2x / year
Ofatumumab 2020 Subcutaneously 1x / 4 weeks TBD
Ublituximab 2021 Intravenously 2x / year TBD
Interferons
IV Potent
Immunomodulators
T-Cell Targeted Orals
CD20s
$448
$162
$1,732
$1,915
$643
$475
$1,864
$4,274
$1,945
$3,380
$2,406
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Ublituximab Value Proposition in MS
Equal to better activity with comparable safety
Convenience of 1 hour infusion every 6 months v.
3-4 hours for Ocrelizumab
Strategically priced to optimize patient access
Estimate $1-2B annual market opportunity in
the US alone for ublituximab in MS
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Targeted Key Data & Potential Filings/Approvals
Clinical
Regulatory
2H2019 - 1H2020 2H2020
Top-Line
UNITY-FL
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Corporate & Financial
TGTX (NASDAQ)
$7.93 (close on 11/19/2019)
~$96M (proforma as of 9/30/19)
~103M (fully-diluted, as of 8/2/2019)
Key Financial Statistics
Ticker:
Price:
Shares:
Cash:
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NASDAQ: TGTX